Tuesday, March 20, 2007

As returning troops make their way home stateside, incidents of inward (suicide) and outward (assault, domestic violence, murder) violence are increasingly reported in the media. Since 2005, ePluribus Media and I have been collecting these reports in the PTSD Timeline for future research, study and reporting.

It is a scratches-the-surface effort; though they are merely a collection of some of the more sensational of incidents and no hard statistics can be gleaned from the data, it is one small attempt to reveal the fact that some are, indeed, slipping through the cracks after having served their country. [We always need more volunteers to help with the tracking and data entry; please email ePluribus Media if you'd like to become a part of the team and help with our project, or if you have an incident to report.]

These incidents are not to be taken as some form of broad generalization about our military service members. Indeed, incidents of suicide and violence take place among the general population as well. But the direct link between society's role in placing these men and women into harm's way is what makes tracking and considering the cases important. Further research needs to move forward. We need to continually hone our understanding of how, if as a society we must send our troops into war, we can improve their rate of successful reintegration once they make their way back to us.

[A] growing number of soldiers...have returned from the war in Iraq only to become entangled in the criminal justice system at home. Some have committed minor offenses; others are facing serious charges of domestic violence and even homicide. Many are struggling with psychological issues as they try to adjust to civilian life.

No one tallies the number of soldiers and veterans in the criminal justice system, so it's impossible to know how many criminal cases involving Iraq war veterans are pending nationwide. But as the war enters its fifth year this month, the conflict is coming home in yet another painful way. ...

"It's a brazen indicator, as Iraq war veterans enter the criminal justice system, that there are untended psychic wounds," said Jim Barker of San Jose, a Vietnam veteran who worked as a psychiatric clinician at the Veterans Administration Hospital in Palo Alto until retiring in 2005. "The coordination of care needs to be sharpened up."

Military officials and veterans advocates emphasize that the overwhelming majority of returning soldiers are law-abiding citizens who have not run afoul of the law. And psychiatric clinicians such as Barker point out that most people with mental health issues do not commit crimes. ...

While most are making successful transitions, others are not:

Some Iraq war veterans who have landed in jail have already been diagnosed with post-traumatic stress disorder. Others may have mental health issues that predated their deployment. Despite stepped-up outreach efforts, clinicians acknowledge that thousands of Iraq and Afghanistan veterans struggle in isolation and are reluctant to seek treatment, often "self-medicating" with alcohol and drugs.

Advocates for veterans say the criminal cases are evidence that returning soldiers are not receiving the mental health care they need. "This new generation of veterans has experienced combat very recently, and it's very raw," said Dick Talbott, who oversees 31 community-based vet centers in California, Oregon, Hawaii and Guam. "They are going to need more intensive and frequent counseling from us, a greater level of care and more staff."

Not surprised to see tireless veterans' advocate Steve Robinson of Veterans for America making one of the best points I've seen -- one that needs to be forcefully presented about such cases as they come into the media spotlight:

Steve Robinson, director of veterans affairs for Veterans for America, says it is critical to determine what mental health care any veteran charged with a crime has received. "If a veteran gets a DUI or is charged with domestic violence or murders his wife, I want to know: What kind of mental health treatment did he get before he separated from the military?" Robinson said. "What kind of treatment is he getting from the VA? Did we do everything we could to help him reintegrate into society? And the answer is usually no."

Some clinicians talk about a phenomenon known as "pancaking" — when a veteran's life collapses. The downward spiral often includes alcohol or drug abuse, a fractured family, joblessness and homelessness. "If you think that society has betrayed you, if you don't have a job, if your family has broken up, if you can't get VA health care or benefits, or if you don't have a place to live, then you may get involved in petty crime to make ends meet," said Paul Sullivan, a former VA project manager who testified to Congress this month.

While most of the draftees in Vietnam were young and single, "a lot of the guys who have gone to Iraq are older, married and have kids," said San Jose's Barker, an Army intelligence specialist in the Vietnam war. "Now you have a family in crisis, not just an individual in crisis."

But there is some light out there, as thoughtful individuals in local communities react to the reality with enlightened programs:

In Massachusetts, the Norfolk County District Attorney's Office has launched an unprecedented effort to prepare police officers and others to interact with soldiers and veterans who may pose risks to themselves and others. Mindful that more than 1.6 million Americans have now served in Iraq and Afghanistan, the office is training police and probation officers, firefighters and emergency medical technicians on the signs of PTSD. ...PTSD "manifests itself in many ways, and we want our first-responders to recognize this," said Norfolk County District Attorney William Keating. "It's not a get-out-of-jail-free card, but if a veteran has a brush with the law, we need to help him."

Keating's uncle struggled with PTSD after serving in World War II, and that inspired him to launch the program. His office has created a 10-minute training video, available on YouTube, in the hope that increased public awareness will reduce veteran-related crime.

"As the trickle of soldiers coming back from Iraq becomes a flood, more of these kinds of cases are going to happen," Keating said. "Helping veterans assimilate and get the kind of treatment they need - even if they are in the criminal justice system - is the least we can do."

My great admiration for such programs that meet this challenge with care and concern for community and returning soldier alike.

After watching Vietnam veterans self-medicate with alcohol and drugs, or act out in anger, California passed a law years ago under which post-traumatic stress disorder could be considered when punishing former troops for crimes associated with those behaviors.

The law, however, covered only veterans of the Vietnam era. But as of January, California’s Alternative Sentencing for Service Members with PTSD law was expanded to include veterans of Iraq and Afghanistan.

Rather than toss combat veterans in jail, the state law gives judges discretion to place them on probation if they enter a voluntary treatment program. The program is available for veterans diagnosed with PTSD, substance abuse, or other mental health issues associated with combat service.

Activists from the Armed Forces Retirees Association and the Vietnam Veterans of America worked for two years to add recently returned veterans to the list of those eligible under the bill. ... “Hopefully, this will be in sharp contrast to what occurred with the Vietnam War veteran who ended up in prison because of a lack of understanding of PTSD,” said Pete Conaty, a retired lieutenant colonel and Vietnam veteran who pushed for the law.

“Previous law limited eligibility to Vietnam veterans, thus making an outdated assertion that Vietnam veterans are the only service members affected with PTSD.”

California is the first such state to offer this protection to OEF/OIF troops coping with PTSD.

While a wide variety of events can trigger what's called post-traumatic stress disorder, this PTSD blog focuses solely on the combat-related variety.
As a new generation of warriors returns to civilian life and seeks out resources, PTSD Combat is here to help.

Considerable Quotes

"The first shamans earned their keep in primitave societies by providing explanations and rituals that enabled man to deal with his environment and his personal anguish. Early man, no less than we, dealt with forces that he could not understand or control, and he attempted to come to grips with his vulnerablity by trying to bring order to his universe." -- Richard Gabriel in No More Heroes

"War stories end when the battle is over or when the soldier comes home. In real life, there are no moments amid smoldering hilltops for tranquil introspection. When the war is over, you pick up your gear, walk down the hill and back into the world." -- OIF vet John Crawford in The Last True Story I'll Ever Tell

"After wars' end, soldiers once again become civilians and return to their families to try to pick up where they left off. It is this process of readjustment that has more often than not been ignored by society. -- Major Robert H. Stretch, Ph.D in Textbook of Military Medicine: Vol. 6 Combat Stress

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